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Optimizing the implementation of Enhanced Barrier Precautions in community-based nursing homes
Stephanie Mayoryk1, Lyndsay M O'Hara1, Gwen L Robinson1
1Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
American Journal of Infection Control
|September 22, 2024
Summary
Enhanced Barrier Precautions (EBPs) in nursing homes significantly improved glove and gown use and resident identification for multidrug-resistant organism (MDRO) control. Implementation success depended on addressing facility-specific barriers and facilitators.
Area of Science:
- Infection Control
- Quality Improvement in Healthcare
- Nursing Home Care
Background:
- Enhanced Barrier Precautions (EBPs) are recommended for nursing home residents to prevent multidrug-resistant organism (MDRO) transmission.
- Optimal implementation strategies for EBPs remain unclear, despite their inclusion in guidelines.
Purpose of the Study:
- To optimize the implementation of EBPs in Maryland nursing homes using a quality improvement initiative.
- To assess the impact of the initiative on EBP adherence and identify barriers and facilitators.
Main Methods:
- A quality improvement (QI) initiative using the 4E process model (engagement, education, execution, evaluation) was implemented in four Maryland nursing homes.
- Semistructured interviews with healthcare personnel (HCP) were conducted to understand EBP acceptability.
Main Results:
- Glove use increased from 85% to 97% (P < .01) and gown use from 27% to 78% (P < .01).
- Accuracy in identifying eligible residents improved from 63% to 99% (P < .01).
- Key facilitators included HCP belief in MDRO reduction; a primary barrier was uncomfortable gowns.
Conclusions:
- EBP implementation is complex, requiring facility-specific assessments of barriers and facilitators.
- HCP interviews provided valuable insights into barriers and facilitators for future EBP implementation projects.
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